Current through September 17, 2024
This section applies to medical services in Medicaid
fee-for-service and Managed Care.
004.01
DEFINITIONS.
The following definitions apply to this section:
004.01(A)
CHILD. An
individual under 19 years of age.
004.01(B)
COMPARABLE
SERVICE. A service provided face-to-face.
004.01(C)
DISTANT
SITE. The location of the provider of the telehealth
service.
004.01(D)
ORIGINATING SITE. The location of the client at the
time of the telehealth consultation.
004.01(E)
TELEHEALTH
CONSULATION. Any contact between a client and a health care
practitioner relating to the health care diagnosis or treatment of such client
through telehealth. For the purposes of telehealth services, a consultation
includes any service delivered through telehealth.
004.01(F)
TELEMONITORING. The remote monitoring of a client's
vital signs, biometric data, or subjective data by a monitoring device which
transmits such data electronically to a health care practitioner for analysis
and storage.
004.02
APPLICABLE LAWS. Health care practitioners providing
telehealth services must follow all applicable state and federal laws and
regulations governing their practice and the services they provide.
004.03
ORIGINATING
SITES. Health care practitioners must ensure that the originating
sites meet the standards for telehealth services. Originating sites must
provide a place where the client's right to receive confidential and private
services is protected.
004.04
INFORMED CONSENT. Before an initial telehealth
consultation, the health care practitioner must provide the client the
following written information which must be acknowledged by the client in
writing or via email:
(A) Alternative options
are available, including in-person services. These alternatives are
specifically listed on the client's informed consent statement;
(B) All existing laws and protections for
services received in-person also apply to telehealth, including:
(i) Confidentiality of information;
(ii) Access to medical records; and
(iii) Dissemination of client identifiable
information;
(C) Whether
the telehealth consultation will be or will not be recorded;
(D) The identification of all the parties who
will be present at each telehealth consultation, and a statement indicating
that the client has the right to exclude anyone from either the originating or
the distant site; and
(E) The
written consent form becomes a part of the client's medical record and a copy
must be provided to the client or the client's authorized
representative.
004.05
BEHAVIORAL HEALTH SERVICES FOR CHILDREN. For each
client who is a child who is receiving telehealth behavioral health services,
the following protections must be in place:
(A) An appropriately trained staff member or
employee familiar with the child's treatment plan or familiar with the child
must be immediately available in person to the child receiving a telehealth
behavioral consultation in order to attend to any urgent situation or emergency
that may occur during provision of such service. This requirement may be waived
by the child's parent or legal guardian. The medical record must document the
waiver; and
(B) In cases in which
there is a threat that the child may harm himself or herself or others, before
an initial telehealth consultation the health practitioner must work with the
child and his or her parent or guardian to develop a safety plan. Such plan
must document actions the child, the health care practitioner, and the parent
or guardian will take in the event of an emergency or urgent situation
occurring during or after the telehealth consultation. Such plan may include
having a staff member or employee familiar with the child's treatment plan
immediately available in person to the child if such measures are deemed
necessary by the team developing the safety plan.
004.06
TELECOMMUNICATIONS
TECHNOLOGY COSTS. Telehealth services and transmission costs are
covered by Medicaid when:
(1) The technology
used meets industry standards;
(2)
The technology is Health Insurance Portability and Accountability Act of 1996
(HIPAA) compliant; and
(3) The
telehealth technology solution in use at both the originating and the distant
site must be sufficient to allow the health care practitioner to appropriately
complete the service billed to Medicaid.
004.06(A)
STANDARDS.
The standards above apply to any peripheral diagnostic scope or device used
during the telehealth consultation.
004.06(B)
COVERAGE.
Coverage is available for teleradiology services when the services meet the
American College of Radiology standards for teleradiology.
004.07
TELEMONITORING
REIMBURSEMENT. Medicaid will reimburse for telemonitoring when all
of the following requirements are met:
(1)
The services are from the originating site;
(2) The client is cognitively capable to
operate the equipment or has a willing and able person to assist in the
transmission of electronic data;
(3) The originating site has space for all
program equipment and full transmission capability; and
(4) The provider must maintain a client's
record containing data supporting the medical necessity of the service, all
transmissions and subsequent review received from the client, and how the data
transmitted from the client is being utilized in the continuous development and
implementation of the client's plan of care.
004.07(A)
PER DIEM
RATE. Telemonitoring is paid at a daily per diem rate set by
Medicaid and includes the following:
(i)
Health care practitioner review and interpretation of the client
data;
(ii) Equipment and all
supplies, accessories, and services necessary for proper functioning and
effective use of the equipment;
(iii) Medically necessary visits to the home
by a health care practitioner; and
(iv) Training on the use of equipment and
completion of necessary records.
004.07(B)
FIXED
PAYMENT. No additional or separate payment beyond the fixed
payment is allowable.
004.08
PRACITIONER CONSULTATION
REIMBURSEMENT. Medicaid will reimburse a consulting health care
practitioner when all of the following requirements are met:
(1) After obtaining and analyzing the
transmitted information, the consulting health care practitioner reports back
to the referring health care practitioner;
(2) The consulting health care practitioner
must bill for services using the appropriate modifier; and
(3) Payment is not made to the referring
health care practitioner who sends the medical documentation.
004.08(A)
EXCLUSIONS. Practitioner consultation is not covered
for behavioral health services when the client has an urgent psychiatric
condition requiring immediate attention by a licensed mental health
practitioner.
004.09
REIMBURSEMENT OF TELEHEALTH. Telehealth services are
reimbursed by Medicaid at the same rate as the service when it is delivered in
person in accordance with each service specific chapter in Title 471
NAC.
004.10
REIMBURSMENT OF ORGINATION SITE FEE. The originating
site fee is paid to the Medicaid-enrolled facility hosting the client for
telehealth services at a rate set forth in the Medicaid fee schedule or under
arrangement with the Managed Care Organization (MCO).
004.11
OUT-OF-STATE TELEHEALTH
SERVICES. Out-of-State telehealth services are covered if the
telehealth services otherwise meet the regulatory requirements for payment for
services provided outside Nebraska and:
(A)
When the distant site is located in another state and the originating site is
located in Nebraska; or
(B) When
the Nebraska client is located at an originating site in another state, whether
or not the provider's distant site is located in or out of Nebraska.
004.12
DOCUMENTATION. The medical record for telehealth
services must follow all applicable statutes and regulations on documentation.
The use of telehealth technology must be documented in the same medical record,
and must include the following telehealth information:
(A) Documentation of which site initiated the
call;
(B) Documentation of the
telecommunication technology utilized; and
(C) The time the service began and
ended.
